Jackson, Edgar Basil

Jackson, Edgar Basil is an individual health care provider with primary practice located at 1225 W Mitchell St 223, Milwaukee WI 53204-3383. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Jackson, Edgar Basil can be contacted via phone (414) 383-4455.

Contact Information

Primary practice address
1225 W Mitchell St 223 Milwaukee WI 53204-3383
Phone: (414) 383-4455
Fax: (414) 727-8730
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 2084A0401X AJ8930984 XJ8930984 Wisconsin
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 13939-20 Wisconsin

Profile Details

NPI number 1598833410
LBN Legal business name Jackson, Edgar Basil
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2006
Last updated Jul 3rd, 2024 - about 4 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598833410 NPPES
Wisconsin Other 1598833410 NPI
Wisconsin MEDICAID 30954700 NPI

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